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P. Kalokerinos
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P2.14 - Radiotherapy (ID 715)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.14-020b - Prognostic factors in unresectable stage III NSCLC treated with concurrent chemoradiotherapy (ID 10233)
09:30 - 09:30 | Author(s): P. Kalokerinos
- Abstract
Background:
Despite recent advances in combined chemoradiotherapy for the management of locally advanced, unresectable, stage III non-small cell lung cancer, the majority of patients treated ultimately relapse from their disease. Identifying prognostic factors that predict outcome may improve patient selection for definitive therapy and provide relevant clinical information for their future care.
Method:
This retrospective analysis assessed survival data for a consecutive series of patients with stage III non-small cell lung cancer treated with 6 weeks of curative-intent carboplatin (AUC 2) - paclitaxel (45mg/m[2]) plus radiotherapy at the Princess Alexandra Hospital, Brisbane, between January 2009 and December 2015. Kaplan-Meier analysis on an intention-to-treat basis was used to assess survival data, with attention to a number of clinicopathologic subgroups. Cox proportional hazards regression was performed on continuous and discrete patient covariates to identify those with an independent association with survival.
Result:
The study included 171 patients, with a median follow-up time of 30.5 months. Median overall survival (mOS) was 27.3 months (95% CI = 22.6 - 33.0) for the entire cohort. An improved mOS was seen in stage IIIA (34.3mo) vs IIIB (13.1mo, p<0.001) patients, and with non-squamous compared to squamous histologic subtype (35.5mo vs 22.7mo, p = 0.022). A longer mOS in females compared to males did not meet statistical significance (27.7mo vs 23.2mo, p = 0.21). Multivariate analysis revealed four factors most strongly and independently associated with poor survival: serum neutrophil:lymphocyte ratio (HR 1.15 for each unit increase, p <0.001), lactate dehydrogenase (HR 1.28 for each 50 U/L increase, p = 0.005), alkaline phosphatase (HR 1.1 for each 20 IU/L increase, p = 0.045), and albumin (inverse relationship, HR 0.76 for each 5 g/L increase, p = 0.047).
Conclusion:
This analysis confirms that outcomes for our cohort of stage III non-small cell cancer patients are consistent with international best practice. Our subgroup analyses were also in keeping with recognised clinical factors asociated with improved survival including earlier stage tumours and non-squamous histopathology. A number of pre-treament blood parameters, less well established as prognostic factors, independently influenced survival including the neutrophil:lymphocyte ratio, and lactate dehydrogenase, alkaline phosphatase and albumin levels. Analysis of oncogenic driver mutation status, PD-L1 expression and degree of tumor-infiltrating lymphocytes in available tumor samples is planned, with the goal of establishing a prognostic model to stratify and direct treatment options in this cohort of potentially curable patients.
